Hillman Richard J, van Leeuwen Marina T, Vajdic Claire M, McHugh Leo, Prestage Garrett P, Botes Leon P, Zablotska Iryna, Medley Gabriele, Tabrizi Sepehr N, Grulich Andrew E, Jin Fengyi
Sexually Transmitted Infections Research Centre, University of Sydney, Marion Villa, Westmead, Australia.
Sex Health. 2012 Dec;9(6):574-9. doi: 10.1071/SH11139.
We report the prevalence and predictors for high-grade anal intraepithelial neoplasia (HGAIN) in community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia.
A cross-sectional study of consecutive participants in both cohorts was performed in 2005 (204 HIV-negative and 128 HIV-positive men). Anal swabs collected by a research nurse underwent cytological analysis, using the ThinPrep procedure, and human papillomavirus (HPV) testing. Participants who had cytological abnormalities other than low-grade squamous epithelial lesions (SIL) were referred for high resolution anoscopy (HRA).
A total of 114 men had cytological abnormalities (24.3% of HIV-negative and 57.5% of HIV-positive men, odds ratio (OR)=4.21, 95% confidence interval (CI) 2.57-6.90). However, only three (2.3%) HIV-positive men and no HIV-negative men had high-grade SIL on anal cytology. Seventy-seven men were referred for HRA, of whom 63 (81.8%) attended. Histologically confirmed HGAIN was detected in 21 (33.3%). The prevalence of HGAIN was higher in HIV-positive men (10.8%) than in HIV-negative men (5.0%, OR=2.29, 95% CI 0.93-5.63, P=0.071). HGAIN was not related to age but was strongly associated with the detection of high-risk types of anal HPV (OR=10.1, 95% CI 1.33-76.2) rather than low-risk types (OR=1.97, 95% CI 0.74-5.25).
HGAIN was prevalent in homosexual men across all age groups and was more than twice as common in HIV-positive men compared with HIV-negative men. The presence of high-risk anal HPV was highly predictive of HGAIN.
我们报告了澳大利亚悉尼基于社区的HIV阴性和HIV阳性同性恋男性队列中高级别肛门上皮内瘤变（HGAIN）的患病率及预测因素。
2005年对这两个队列的连续参与者进行了一项横断面研究（204名HIV阴性男性和128名HIV阳性男性）。由研究护士采集的肛门拭子采用ThinPrep程序进行细胞学分析及人乳头瘤病毒（HPV）检测。除低度鳞状上皮内病变（SIL）外有细胞学异常的参与者被转诊进行高分辨率肛门镜检查（HRA）。
共有114名男性存在细胞学异常（HIV阴性男性中占24.3%，HIV阳性男性中占57.5%，优势比（OR）=4.21，95%置信区间（CI）2.57 - 6.90）。然而，仅3名（2.3%）HIV阳性男性肛门细胞学检查显示高级别SIL，HIV阴性男性中无人有此情况。77名男性被转诊进行HRA，其中63名（81.8%）接受了检查。组织学确诊的HGAIN在21名（33.3%）中被检测到。HIV阳性男性中HGAIN的患病率（10.8%）高于HIV阴性男性（5.0%，OR = 2.29，95% CI 0.93 - 5.63，P = 0.071）。HGAIN与年龄无关，但与高危型肛门HPV的检测密切相关（OR = 10.1，95% CI 1.33 - 76.2），而非低危型（OR = 1.97，95% CI 0.74 - 5.25）。
HGAIN在所有年龄组的同性恋男性中都很普遍，与HIV阴性男性相比，在HIV阳性男性中的发生率高出两倍多。高危肛门HPV的存在对HGAIN具有高度预测性。
